WPCNR'S ADAM IN ALBANY. By Assemblyman Adam T. Bradley, 89th Assembly District. August 21, 2006: I am pleased to announce that the governor has signed into law legislation that I authored (A.11996/S.8417) that will bring sweeping reforms to the health care system. The measure will establish fair, uniform and consistent procedures for the processing of health claims, the processing of overpayment recovery claims and the credentialing of physicians by health plans. It will also help to level the playing field between powerful HMOs and our hospitals and physicians.
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Inconsistent and cumbersome procedures cause physicians and hospitals to waste valuable resources dealing with the administrative burdens of health care plans, rather than treating patients. To address these issues, the new law would enact much needed reforms by attempting to assure fairness, uniformity and consistency for physicians, hospitals and health plans.
Specific provisions of the law include:
· requiring Health Plans to accept the American Medical Association's Current Procedural Terminology (CPT) codes when processing all health care claims
· limiting the time period for health plans to demand refunds from 6 years to 24 months, with limited exceptions; and
· requiring health plans to complete physician credentialing to participate in the insurer’s network within 90 days.
This bipartisan legislation responds to common health care concerns such as dealing with confusing health plan rules used to adjudicate claims submitted by physicians and hospitals, excessive demands for refunds of claims paid several years in the past, and unjustifiable delays by health plans in credentialing physicians to participate in the health plans network.
I want to thank The Westchester County Association, The New York State and Westchester County Medical Society, NYPIRG and The Northern Metropolitan Hospital Association for the tremendous support and advocacy they provided which helped lead to the passage of these very important health care reforms.
I will continue working in a bipartisan fashion to ensure that our healthcare system works for the New Yorkers it was designed to serve – not the bureaucrats that have been lining their pockets with hefty profits. By making our health insurance regulations more efficient, we can reach the goal of putting patients before profits.
Adam T. Bradley
